131 articles - From Friday Dec 15 2023 to Friday Dec 22 2023
Guidelines and related publications, position statements, white papers, technical reviews, consensus statements, etc…
| Gastroenterology |
|---|
AGA Clinical Practice Update on Endoscopic Full-Thickness Resection for the Management of Gastrointestinal Subepithelial Lesions: Commentary. The purpose of this American Gastroenterological Association (AGA) Clinical Practice Update (CPU) is to describe the various techniques for endoscopic full-thickness resection and to facilitate their appropriate application in the management of subepithelial lesions. Methods This CPU was commissioned and approved by the AGA Institute Clinical Practice Updates Committee (CPUC) and the AGA Governing Board to provide timely guidance on a topic of high clinical importance to the AGA membership and underwent internal peer review by the CPUC and external peer review through standard procedures of Gastroenterology. |
meta-analyses and systematic reviews
| Aliment Pharmacol Ther |
|---|
Improving primary prophylaxis of variceal bleeding by adapting therapy to the clinical stage of cirrhosis. A competing-risk meta-analysis of individual participant data. In patients with compensated cirrhosis and high-risk varices on primary prophylaxis, NSBBs significantly improved survival vs EVL, with no additional benefit noted adding EVL to NSBBs. In decompensated patients, survival was similar with both therapies. The study suggests that NSBBs are preferable when advising preventive therapy in compensated patients. |
| Am J Gastroenterol |
Performance of prediction models for esophageal squamous cell carcinoma in general population: a systematic review and external validation study. Several prediction models showed moderate performance in external validation and the prediction models may be useful in screening for ESCC. Further research is needed on model optimization, generalization, and implementation, as well as health economic evaluation. |
| Hepatology |
RCT, clinical trials, retrospective studies, etc…
| Aliment Pharmacol Ther |
|---|
Clinical trial: Combination allopurinol-thiopurine versus standard thiopurine in patients with IBD escalating to immunomodulators (the DECIDER study). Thiopurine-allopurinol therapy is safe and mitigates thiopurine adverse effects, thus enhancing tolerability without compromising efficacy (ACTRN12613001347752). |
| Am J Gastroenterol |
EPIDEMIOLOGY, COMORBIDITIES, AND TREATMENT OF CYCLIC VOMITING SYNDROME IN THE UNITED STATES. This study provides the first population-level estimates of CVS incidence and prevalence in the US. Comorbid conditions are common, and most patients with CVS do not receive adequate treatment. These findings underscore the need for improving disease awareness and developing better screening strategies and effective treatments. |
Measuring size of colorectal polyps using a virtual scale endoscope or visual assessment: A randomized controlled trial. VSE significantly improves the size measurement accuracy of colorectal polyps during colonoscopies compared to VA and results in fewer misclassifications at relevant decision-making size thresholds. |
Potential Cost Savings in Medicare Part D Across Gastroenterology; An Assessment of Alternative Drug Sourcing. Disproportionate Part D spending likely reflects less competitive acquisition cost. Provider awareness of medications with advantaged price may promote targeted prescribing with potentially tremendous healthcare savings. |
Understanding predictors of fatigue over time in persons with IBD: The importance of depressive and anxiety symptoms. Anxiety, depression and pain predicted fatigue impact over time in IBD, suggesting that targeting psychological factors and pain for intervention may lessen fatigue burden. |
Utilizing the Diabetes Care System for A County-wide Hepatitis C Elimination: An Integrated Community-based Shared Care Model in Taiwan. Although HCV prevalence varied, the care cascades achieved consistent results across townships/cities. We have further successfully implemented the model in county-wide hospital-based diabetes clinics, eventually treating 89.6% of the total PwD. A collaborative effort between diabetes care and HCV elimination enhanced the testing and treatment in PwD through an innovative shared care model. |
| Clin Gastroenterol Hepatol |
Older patients with ACLF have a higher waitlist mortality, but acceptable post-LT survival when compared to younger patients. Older patients with Est-CLF had significantly higher waitlist mortality than younger patients, but had acceptable 1-year post-LT survival including those with Est-ACLF-3; therefore age alone should not be considered as a contraindication for LT. Older patients with respiratory failure should be carefully selected for LT. |
| Endosc Int Open |
Analysis of adverse events with lumen apposing metal stents for drainage of pancreatic fluid collections. Endoscopists should be aware of the risk factors for LAMS-related bleeding and tailor their drainage strategy, including utilization of plastic stents for drainage of pseudocysts and adherence to a strict imaging interval and follow-up protocol. |
Antibiotic prophylaxis and post-procedure infectious complications in endoscopic retrograde cholangiopancreatography with peroral cholangioscopy. No reduction in infectious complication rates and AEs was seen with AP administration for SOC. The continued need for AP in SOC remains uncertain. |
Endoscopic ultrasound-guided perivascular pancreatic radiofrequency ablation using a hydroxyethyl starch solution prior to pancreatectomy. Preoperative perivascular augmented RFA using HES was safe, and in the pancreatic animal model, the best timeframe was within 24 hours before pancreatic surgery. This technique might improve resectability in selected borderline and locally advanced pancreatic cancers. |
Management of foreign body ingestion in adults: Time to STOP and rethink endoscopy. Conservative management for patients presenting with recurrent high-risk foreign body ingestion was safe in appropriately selected cases. Re-presentation is common and poses significant challenges for health care providers. |
Repeat bidirectional double-balloon enteroscopy 1 year later may be proper in Peutz-Jeghers patients with difficult-to-reach polyps. The difficult-to-reach polyps may have a low risk of immediate symptomatic intussusception, possibly due to limited bowel mobility by extraluminal adhesions, and the likelihood of reaching them at repeat DBE was substantial. Hence, repeat DBE 1 year later may be proper in such patients with PJS. |
Utility of gastroscopy in the left lateral semi-recumbent position: A blood-free coup! These data show that endotherapy in the left lateral semi-recumbent position is feasible, safe, and effective. It should be done when endoscopy in the left lateral decubitus position reveals a pool of blood in the fundus and there is inadequate visualization of the fundus. |
| Endoscopy |
Post-colonoscopy colorectal cancers in a national FIT-based CRC screening program. The 3-year PCCRC rate was low in this FIT-based CRC screening program. Approximately half of PCCRCs were interval PCCRCs. These were mostly caused by missed lesions and were diagnosed at more advanced stage. This emphasizes the importance of high-quality colonoscopy with optimal polyp detection. |
| Gastroenterology |
A Randomized Controlled Phase 2 Dose-Finding Trial to Evaluate the Efficacy and Safety of Camostat in the Treatment of Painful Chronic Pancreatitis: The TACTIC Study. We were not able to reject the null hypothesis of no difference in improvements in pain or quality of life outcomes in participants with painful CP who received camostat compared to placebo. Studies are needed to further define mechanisms of pain in CP to guide future clinical trials, including minimizing placebo responses and selecting targeted therapies. (NCT02693093). |
Dysbiosis and associated stool features improve prediction of response to biological therapy in inflammatory bowel disease. Faecal characterization based on microbial load, moisture content, calprotectin concentration, and enterotyping may aid in the therapeutic choice of biological therapy in IBD. |
Fibroblast-Derived Lysyl Oxidase Increases Oxidative Phosphorylation and Stemness in Cholangiocarcinoma. Increased LOX is driven by stromal inflammatory cancer-associated fibroblasts and correlates with diminished survival of patients with CCA. Modulating the LOX activity can serve as a novel tumor microenvironment-directed therapeutic strategy in bile duct pathologies. |
Sex, genotype, and liver volume progression as risk of hospitalization determinants in autosomal dominant polycystic liver disease. Both imaging and clinical genetic scoring have the potential to inform patients about the risk of developing symptomatic disease throughout their lives. The combination of female sex, germline PRKCSH alteration, and rapid TLV-progression is associated with the greatest odds of PLD-related hospitalization. |
| Gastrointest Endosc |
Bilevel positive airway pressure ventilation in patients susceptible to hypoxemia during procedural sedation for colonoscopy: A prospective randomized controlled study. In individuals with OSA or overweight status, the use of BPAP ventilation during colonoscopy significantly reduced the incidence of hypoxemia. |
Biliary Drainage in Hilar and Perihilar Cholangiocarcinoma; 25-Year Experience at a Tertiary Cancer Center. The relatively higher clinical success of SEMS is countered by the higher stent-specific complication rate. PS can be removed and may better facilitate PTBD. Within PS types, DPTs may have fewer stent-specific AEs. Cases requiring balloon dilation and with endoscopic evidence of pus may benefit from earlier reintervention. |
Does successful EUS-guided pancreatic cyst chemoablation safely allow reduction in the frequency of radiographic surveillance? Long-term follow-up of randomized prospective data. The ChARM Post-Treatment Reduced Radiographic Surveillance Protocol safely allows a reduction in radiographic surveillance. A reduction in cost associated with cyst management under the ChARM protocol was shown when compared to management following Fukukoa or ACG guidelines. According to the questionnaire, most patients reported a moderate level of logistical and emotional burden associated with MRI surveillance, and a majority were in favor of reducing the frequency of radiographic surveillance if it can be done without a marked increase in oncologic risk. |
Outcomes of Cold Snare Endoscopic Mucosal Resection of Nonampullary Duodenal Adenomas =1 cm: A Multicenter Study. This retrospective multicenter study demonstrates that cs-EMR for nonampullary duodenal adenomas is safe and technically feasible with an acceptable recurrence rate. Future prospective studies are needed to directly compare outcomes of cs-EMR with conventional and underwater EMR. |
Safety and Efficacy of Direct Percutaneous Endoscopic Jejunostomy Tube Placement Compared with Surgical Jejunostomy: A Tertiary Care Analysis. DPEJ is a safe and effective alternative to surgical jejunostomy in eligible patients and may be associated with decreased complication rates at 90-days. |
| Hepatology |
Adjuvant and neoadjuvant therapies for hepatocellular carcinoma. Moreover, major pathological responses reported from early phase 2 data in the neoadjuvant setting provide a strong rational for the evaluation of these concepts in phase 3 trials. In this review, we summarize current evidence and outline future directions for systemic therapies in early-stage hepatocellular carcinoma. |
Association of glucagon-like peptide-1 receptor agonists with serious liver events among patients with type 2 diabetes: A scandinavian cohort study. Use of GLP-1 receptor agonists was associated with a significantly reduced risk of serious liver events, driven by a reduction of compensated and decompensated cirrhosis. |
Defining an approach for therapeutic strategies in metabolic dysfunction-associated steatotic liver disease after liver transplantation. Despite the oversized clinical burden of MASLD among LT recipients, there is currently a lack of regulatory approach and pathway for therapeutics development in this patient population. The present document, thus, provides guidance for therapeutics development that incorporates nuances of transplant care in patients with post-LT MASLD to facilitate drug development. |
Effects of trientine and penicillamine on intestinal copper uptake: A mechanistic 64Cu PET/CT study in healthy humans. In this mechanistic study, we show that TRI inhibits intestinal copper absorption, in addition to its cupriuretic effect. In contrast, PEN has modest effects on the intestinal absorption. This may explain why TRI and PEN are equally effective although urinary copper excretion is lower with TRI. The study questions whether the same therapeutic targets for 24-hour urinary excretion apply to both drugs. |
Portable hypothermic oxygenated machine perfusion for organ preservation in liver transplantation (PILOTTM): A randomized, open-label, clinical trial. HMP-O2 demonstrates safety and noninferior efficacy for liver graft preservation in comparison to SCS. EAD by L-GrAFT7 was lower in HMP-O2, suggesting improved early clinical function. Recipients of HMP-O2 livers also demonstrated a lower incidence PNF and biliary strictures, although this difference did not reach significance. |
Prevalence, distribution and hepatic fibrosis burden of the different subtypes of steatotic liver disease in primary care settings. Almost al the NAFLD patients met the new criteria for MASLD. The fibrosis burden of the MetALD group was higher than those of the MASLD and ALD groups. |
Sumoylation of methionine adenosyltransferase alpha 1 promotes mitochondrial dysfunction in alcohol-associated liver disease. Taken together, our findings demonstrate an essential role for SUMOylation of MATa1 K48 for interaction with PIN1 in ALD. Preventing MATa1 K48 SUMOylation may represent a potential treatment strategy in ALD. |
m6A-mediated gluconeogenic enzyme PCK1 upregulation protects against hepatic ischemia-reperfusion injury. Our study found that activation of the METTL3/m6A-PCK1-gluconeogenesis axis is required to protect against hepatic I/R injury, providing potential intervention approaches for alleviating hepatic I/R injury during liver surgery. |
| J Hepatol |
A new clinical and prognostic characterization of the patterns of decompensation of cirrhosis. In almost 50% outpatients the first decompensation is a NAD, which is associated with a decreased survival than patients with ND. Patients who develop NAD must be treated with extreme care and monitored closely to prevent any development of AD. Impact and implications This multicenter study is the first to investigate the role of NAD in patients with cirrhosis. In fact, while the unfavorable impact of AD is well known, NAD is currently a phenomenon existing in clinical practice but never studied. Our data show that almost half of the decompensations in patients with cirrhosis are attributable to NAD and that this involves a higher risk of mortality compared to compensated patients. This study has important clinical implications because it highlights the need to carefully consider patients who develop NAD, in order to prevent further decompensation and reduce mortality. |
An open-label randomised-controlled trial of azathioprine vs. mycophenolate mofetil for the induction of remission in treatment-naive autoimmune hepatitis. In patients with treatment-naive AIH, MMF with prednisolone achieved a significantly higher rate of biochemical remission at 24 weeks compared to azathioprine combined with prednisolone. Azathioprine use was associated with more (serious) adverse events leading to cessation of treatment, suggesting superior tolerability of MMF. Impact and implications This randomised controlled trial directly compares azathioprine and mycophenolate mofetil (MMF), both in combination with prednisolone, for the induction of biochemical remission in treatment-naive patients with autoimmune hepatitis (AIH). Achieving complete remission is desirable to prevent disease progression. Patients assigned to the MMF group reached biochemical remission more often and experienced fewer adverse events. The findings in this trial may contribute to the re-evaluation of international guidelines for the standard of care in treatment-naive patients with AIH. |
Effects of tetrathiomolybdate on copper metabolism in healthy volunteers and in patients with Wilson disease. While we did not show an increase in biliary excretion of 64 Cu following TTM administration, we demonstrated that TTM effectively inhibited most intestinal 64 Cu uptake and retained 64 Cu in the blood stream, limiting 64 Cu exposure to organs like the liver and the brain. Impact and implications Bis-choline tetrathiomolybdate (TTM) is an investigational copper chelator for treatment of Wilson Disease. In animal studies of Wilson Disease models, TTM has been shown to facilitate biliary copper excretion. In the present human study, TTM surprisingly did not facilitate biliary copper excretion but instead reduced intestinal copper uptake to a clinically significant degree. Our study improves the understanding of human copper metabolism and the mechanism of action of TTM. Clinical trial number Data is presented from two clinical trials Absorption study EudraCT 2020-005832-31Excretion study EudraCT 2021-000102-25. |
Episodic overt hepatic encephalopathy after transjugular intrahepatic portosystemic shunt does not increase mortality in patients with cirrhosis. Episodic OHE after TIPS is not associated with mortality in patients undergoing TIPS, regardless of the indication. Impact and implications Overt hepatic encephalopathy (OHE) is a common complication in patients with advanced liver disease and it is particularly frequent following transjugular intrahepatic portosystemic shunt (TIPS) placement. In cirrhotic patients outside the setting of TIPS, the development of OHE negatively impacts survival, regardless of the severity of cirrhosis or the presence of acute on chronic liver failure. With this multicenter, non-inferiority observational study we demonstrated that post-TIPS OHE does not increase the risk of mortality in patients undergoing TIPS, irrespective of the indication. This finding alleviates concerns regarding the weight of this complication after TIPS. Thus, intensive research of factors improving patient selection, and allowing risk stratification remains crucial to ameliorate the quality of life of patients and caregivers and to avoid undermining the positive effects on survival in patients undergoing TIPS. |
Long-term use of tenofovir disoproxil fumarate increases fracture risk in elderly patients with chronic hepatitis B. The risk of fracture increased with TDF treatment for =24 months in elderly patients with CHB. Selection of nucleos(t)ide analogues should be individualised based on age and comorbidities. Impact and implications Previous literature suggested that the use of tenofovir disoproxil fumarate (TDF) is associated with a decrease in bone mineral density. However, data on the impact of TDF on long-term incident clinical fracture remains scarce. In this real-world territory-wide study of 41,531 treated patients with chronic hepatitis B in Hong Kong, patients who received TDF were associated with a higher risk of fracture after two years of treatment as compared to those who received entecavir. Given the ageing population of patients with chronic hepatitis B with a rising prevalence of comorbidities, our findings support the current treatment guidelines on selection of antiviral treatment based on age and comorbidities. |
Preventing liver disease with policy measures to tackle alcohol consumption and obesity: the HEPAHEALTH II study. Policy measures tackling primary risk factors for CLD and liver cancer, such as the implementation of an MUP of €1 and/or an MUP of €0.70 plus SSB tax could markedly reduce the number of Europeans with CLD or liver cancer. |
Plenty of the editorials are available as full text through the publisher website using the provided link
| Aliment Pharmacol Ther |
|---|
| Clin Gastroenterol Hepatol |
Birth cohort colorectal cancer (CRC): implications for research and practice. We also outline implications of birth cohort CRC for epidemiologic and translational research, as well as current clinical practice. We postulate that recognition of birth cohort CRC as an entity - including and extending beyond rising EOCRC - can advance understanding of risk factors, etiologies, and mechanisms, and address the public health consequences of changing CRC epidemiology. |
| Endosc Int Open |
| Gastrointest Endosc |
| J Hepatol |
Battle of the Biopsies: Role of tissue and liquid biopsy in hepatocellular carcinoma. The early results from multianalyte liquid biopsy panels are promising and suggest they could play a transformative role in HCC detection and management, however, comprehensive clinical validation is still ongoing. In this review, we explore the challenges and potential of both tissue and liquid biopsy, highlighting that these diagnostic methods, while distinct in their approaches, are set to jointly reshape the future of HCC management. |
misc publications eg case reports, tools of the trade, images of the month, etc…
| Am J Gastroenterol |
|---|
| Clin Gastroenterol Hepatol |
| Endoscopy |
| Gastroenterology |
| Gastrointest Endosc |
| Hepatology |
| J Hepatol |
Letters to the editors and authors’ replies
| Aliment Pharmacol Ther |
|---|
| Clin Gastroenterol Hepatol |
| Gastroenterology |
| Gastrointest Endosc |
| Gut |
| J Hepatol |